Lower Household Research Articles

Characterizing Older Adults' Travel Behaviour and Unmet Needs: Findings from the Canadian Longitudinal Study on Aging (CLSA).

This study provides researchers, practitioners, and policy makers with a profile of older adults' travel behaviour and the older adult population that reports unmet travel needs. In addition, we quantified associations between reporting an unmet travel need and measures of health and social connectedness. Data came from the second follow-up survey of the Canadian Longitudinal Study on Aging, collected from 2018 to 2021 (n=14,167). Nine in ten (90.2%) older adults aged 65years and older indicated that driving is the main way they get around. Older adults with an unmet travel need were more likely to be women, have lower household incomes and education levels, and have a mobility limitation. People with an unmet travel need had 2.7 times the odds of reporting fair or poor general health (OR=2.66, 95% CI: 2.19, 3.22) and 3.1 times the odds of feeling socially isolated (OR=3.10, 95% CI: 2.57, 3.72) compared to those without an unmet need.

National trends in type 2 diabetes mellitus stratified by central adiposity using waist-to-height ratio in South Korea, 2005–2022

Studies investigating the association between type 2 diabetes mellitus and central adiposity are lacking. Therefore, this study aimed to investigate trends in type 2 diabetes mellitus stratified by central adiposity using waist-to-height ratio (WHtR). Trends in type 2 diabetes mellitus were examined by central adiposity, using WHtR, with data from the Korea National Health and Nutrition Examination Survey (2005–2022). Individuals aged 30 years and over who participated in the survey were selected. Type 2 diabetes mellitus was identified based on serum glucose or HbA1c levels, the use of diabetes medications, or a prior diagnosis by a physician. Weighted β-coefficients or odd ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess changes in disease prevalence. A total of 79,368 participants were included in the database (female: 45,163 [56.9%]). from 2005 to 2022, the prevalence of type 2 diabetes mellitus increased from 3.3 to 5.8% in the healthy central adiposity group, from 11.2 to 17.1% in the increased central adiposity group, and from 18.0 to 26.7% in the high central adiposity group. Males, older population, lower education level, lower household income, and smoking are associated with a higher risk of type 2 diabetes. In the high central adiposity group, overweight and obese individuals had higher susceptibility than underweight or normal-weight individuals, with ORs of 5.85 (95% CI, 2.54–13.47) and 8.24 (3.79–17.94), respectively. The prevalence of type 2 diabetes mellitus has increased in all central adiposity groups in the past decade. This underscores the need for tailored interventions to address disparities and improve diabetes management in at-risk populations.

The roles of employment status and income in the mental health of informal caregivers in Germany

BackgroundInformal caregivers often experience multiple negative consequences as a result of the informal care they provide. Among other factors, employment status, financial resources, and mental health are related to informal caregiving. This analysis examined the association between informal caregivers’ employment status and their mental health, as well as the moderating effect of net household income on this relationship.MethodsThe research question was addressed with data from the German Socio-Economic Panel (SOEP) survey, comprising 3,053 informal caregivers (1,007 male; 2,046 female). Data were obtained through self-reports, and mental health was measured with the Summary Scale Mental Score. Stepwise adjusted multiple linear regression models were used to examine the association between employment status and mental health. The moderating effects were tested with interaction terms. All analyses were also stratified for gender.ResultsInformal caregivers with full-time jobs reported better mental health than unemployed or marginally employed caregivers (β = 0.077, p < 0.001). The significant interaction term for full-time (β=-0.066, p = 0.001) and part-time workers (β=-0.066, p = 0.003) indicated a moderating effect of net household income on the association between employment status and mental health. This finding was especially evident in women.ConclusionsEmployment appears to be a relevant protective factor for informal caregivers’ mental health. However, if informal caregivers are not employed, a low net household income might additionally restrict their mental health. Therefore, welfare policy structures must be created to reduce the negative financial consequences for informal caregivers and enable them to achieve work-life-care balance.

Characteristics associated with adult non-fatal opioid and stimulant overdose and substance use disorder emergency department visits in Michigan

BackgroundUnderstanding risk factors for emergency department (ED) visits for overdose and substance use disorder (SUD) can inform prevention efforts. Few studies have considered non-fatal opioid overdoses, stimulant overdoses and SUD, and limited data exists by overdose intentionality and by sex. MethodsWe conducted a serial cross-sectional study with Healthcare Cost and Utilization Project Michigan (MI) 2019–2020 ED discharge data (n=5,716,716). Primary outcomes included non-fatal opioid overdoses, non-fatal stimulant overdoses, and SUD primary diagnoses in a single ED visit. We examined demographic and socioeconomic factors associated with study outcomes using binary and multinomial logistic regression (for overdose intentionality) models, which estimated adjusted odds ratios (AOR) and 95 % confidence intervals (CI). ResultsAmong all MI discharges, 13,908, 1,379, and 23,462 were nonfatal opioid, stimulant, or SUD overdose visits, respectively. Lower median household income (vs. higher income), male sex (vs. female), metropolitan county of residence (vs. small urban/rural), and Medicaid (vs. private insurance) were associated with increased odds of all outcomes. For example, ORs(95 % CIs) for Medicaid were 4.41(4.18,4.65), 2.25(1.95,2.60), and 2.80(2.70,2.91) for opioid overdoses, stimulant overdoses, and SUD, respectively. All outcomes had the highest increased odds in ages 28–32 years compared to 18–22 years. Stratification by sex and non-fatal overdose intentionality modified some associations, with the strongest associations observed for non-fatal opioid overdoses. ConclusionsMale sex, Medicaid, and race/ethnicity were consistently associated with all outcomes similarly, but other characteristics varied in patterns, strengths of association, and statistical significance by outcome groups, sex, and non-fatal opioid or stimulant overdose intentionality.

National Trends in the Prevalence of Self-Perceived Overweight Among Adolescents Between 2005 and 2022: Nationwide Representative Study.

Despite several studies on self-evaluation of health and body shape, existing research on the risk factors of self-perceived overweight is insufficient, especially during the COVID-19 pandemic. This study aims to identify the risk factors affecting self-perceived overweight and examine how the prevalence of self-perceived overweight has changed before and during the COVID-19 pandemic. Specifically, we analyzed the impact of altered lifestyles due to COVID-19 on this phenomenon. The data used in the study were obtained from middle and high school students who participated in the Korean Youth Risk Behavior Web-based Survey (N=1,189,586). This survey was a 2-stage stratified cluster sampling survey representative of South Korean adolescents. We grouped the survey results by year and estimated the slope in the prevalence of self-perceived overweight before and during the pandemic using weighted linear regression, as well as the prevalence tendencies of self-perceived overweight according to various risk factors. We used prevalence ratios to identify the risk factors for self-perceived overweight. In addition, we conducted comparisons of risk factors in different periods to identify their associations with the COVID-19 pandemic. The prevalence of self-perceived overweight was much higher than BMI-based overweight among 1,189,586 middle and high school participants (grade 7-12) from 2005 to 2022 (female participants: n=577,102, 48.51%). From 2005 to 2019 (prepandemic), the prevalence of self-perceived overweight increased (β=2.80, 95% CI 2.70-2.90), but from 2020 to 2022 (pandemic) it decreased (β=-0.53, 95% CI -0.74 to -0.33). During the pandemic, individuals with higher levels of stress or lower household economic status exhibited a more substantial decrease in the rate of self-perceived overweight. The prevalence of self-perceived overweight tended to be higher among individuals with poor academic performance, lower economic status, poorer subjective health, and a higher stress level. Our nationwide study, conducted over 18 years, indicated that self-perceived overweight decreased during the COVID-19 period while identifying low academic performance and economic status as risk factors. These findings suggest the need for policies and facilities to address serious dieting and body dissatisfaction resulting from self-perceived overweight by developing counseling programs for adolescents with risk factors such as lower school performance and economic status.

Trends in incidence, treatment modalities and prognosis of esophageal adenocarcinoma in the US population

BackgroundEsophageal adenocarcinoma (EAC) was the predominant subtype of esophageal cancer in the Western population. However, an updated and comprehensive analysis of epidemiologic, clinical, and prognostic characteristics of esophageal adenocarcinoma is lacking. Materials and methodsThis was a population-based cohort study using the Surveillance Epidemiology and End-Results (SEER) Database. Patients diagnosed with EAC between 1988 and 2020 were included. Incidence trends, clinical characteristics, treatment patterns, and relative survival were systematically analyzed. ResultsThe overall age-standardized incidence rate of EAC significantly increased from 1.7 per 100000 persons in 1988 to 3.6 per 100000 persons in 2020. There were no significant changes in the distribution of age group, sex, and primary site of EAC over time. However, the proportion of EAC clinically staged as I or II decreased from 35.1 % to 27.9 %. Over time, palliative chemotherapy in metastatic EAC increased from 26.7 % to 41.3 %, combination therapy was still the main treatment strategy for nonmetastatic EAC. Despite the 5-year survival rate was less than 20 %, 1-year survival has experienced a moderate increase from 46.7 % to 53.7 %. Specifically, 1-year survival rate for nonmetastatic EAC undergoing surgery only experienced a significant increase from 80.2 % in 2004–2006 to 94.7 % in 2019–2020. For metastatic EAC, obvious improvement in 1-year survival rate was observed in those treated with systematic therapy (from 26.6 % in 2004–2006 to 41.2 % in 2019–2020). In the multivariable analysis, older age, male sex, lower household income, living without a partner, advanced TNM stage, and receiving no cancer treatment were significantly associated with poor survival. ConclusionIn summary, this population-based study of EAC patients in the US showed an increase in incidence, a shift in treatment modalities for metastatic EAC, and moderately improved 1-year survival. The search for more effective surveillance and treatment strategies should be continued in the future.

Resistance Exercise Participation in Community-Dwelling Older Adults in Korea: Associated Factors and Sex Differences.

Background/Objectives: Despite the importance of resistance exercise in older adults, factors associated with participation remain unclear, especially regarding sex differences. This study investigated sociodemographic, behavioral, and comorbidity factors associated with insufficient resistance exercise participation among community-dwelling older adults in Korea, with analyses stratified by sex. Methods: Nationally representative cross-sectional data from 8671 participants aged ≥65 years (3758 men and 4913 women; mean age 72.8) were analyzed using the 6th-8th Korea National Health and Nutrition Examination Surveys (2014-2019). Complex-sample multivariable logistic regression identified factors associated with insufficient resistance exercise overall and by sex. Results: Women had a higher prevalence of insufficient resistance exercise than men (91.27% vs. 71.04%, p < 0.001). Older age groups, particularly those aged ≥80 years (OR: 2.39; 95% CI: 1.86-3.07), and those with lower education (OR: 1.56; 95% CI: 1.33-1.82), rural residence (OR: 1.89; 95% CI: 1.49-2.38), low household income, (OR: 1.45; 95% CI: 1.13-1.88), insufficient aerobic exercise (OR: 1.68; 95% CI: 1.46-1.94), current smoking (OR: 1.70; 95% CI: 1.26-2.29), and diabetes (OR: 1.28; 95% CI: 1.09-1.51) were independently associated with a higher likelihood of insufficient resistance exercise. The association of household income, current smoking, hypertension, and diabetes with resistance exercise adherence showed differences in sex-stratified analyses. Conclusions: Multiple sociodemographic, behavioral, and comorbid factors are linked to resistance exercise adherence among older Koreans. Tailored, sex-specific interventions are needed to promote resistance exercise in this population, informing public health strategies and further research on effective approaches for diverse older adults.

Effects of Risk and Time Preferences on Diet Quality: Empirical Evidence from Rural Madagascar

Malnutrition is a major concern in Madagascar. Eating a wide variety of nutritious food is necessary because Malagasy diets heavily rely on rice consumption. This study explored the barriers to dietary change towards diversification from the perspective of consumer behaviour. We analysed the impact of risk and time preferences on dietary diversity using economic experiments conducted with 539 rural lowland rice farmers in Central Highlands in Madagascar. The results showed that risk-averse or impatient individuals were more likely to have lower Household Dietary Diversity Score (HDDS), indicating poorer diet quality. Risk-averse people may not want to add different foods to meals as they perceive unfamiliar food as a ‘risk’; people who prefer immediate gratification may fail to invest in nutritious diets now to achieve better health in the future. Additionally, higher HDDS was observed among households with a female head who earned off-farm income and who had frequent market visits. These findings contribute to explaining the limited shift in nutritional transition in Madagascar and provide useful insights into nutritional policies promoting healthier food choices. Depending on the preferences, more focused support such as nutritional education, financial support, market development, and pre-commitment mechanisms could be provided to reward long-term nutritional benefits.

Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study.

Although depression is a frequently occurring mental disorder in patients with hypertension, little is known about the symptoms of depression among Afghan hypertensive patients. This study aimed to analyze the prevalence and predictors of depression symptoms among Afghan hypertensive patients. This was a secondary analysis of a multi-center cross-sectional study conducted between August and December 2022 across three major provinces in Afghanistan. Socio-demographic and clinical characteristics of the eligible participants were used in the analysis. A score of ≥ 5 on the PHQ-9 (Patient Health Questionnaire) was considered the cut-off point for labeling hypertensive patients as screening positive for depressive symptoms. We performed binary logistic regression to determine the predictors of depression symptoms among hypertensive patients. Out of 853hypertensive patients, 51.8% (95% CI: 48.4-55.2%) had depressive symptoms. Binary logistic regression revealed that low monthly household income [AOR=1.42, 95% CI (1.01-1.97), low education level [2.41 (1.57-3.71)], physical inactivity [1.81 (1.22-2.71)], poor blood pressure control [2.41 (1.57-3.71)], and the presence of medical comorbidity [1.59 (1.15-2.19)] were the predictors of depression symptoms. This study showed a high prevalence of depressive symptoms among Afghan hypertensive patients. Moreover, we found that low monthly household income, physical inactivity, low education level, poor blood pressure control, and the presence of medical comorbidity were the predictors of depression symptoms. Our findings suggest that hypertensive patients should be screened for mental health symptoms, and those most at risk for depression should seek supportive counseling.

Associations of serial negative income shock and all-cause mortality: a longitudinal study in China

IntroductionWith a precarious economic outlook and increasing income volatility in current times, understanding the association between negative income shock and health is crucial. However, few studies have examined such associations...

Comparative Analysis of Food and Nutrition Security in Pakistan: Implications for Sustainable Development Policies

Food and nutrition security is a critical issue for Pakistan, with over half of the population living in deprivation. Poor nutrition is one of the primary reasons for morbidity and mortality, particularly among children and women. This research compared food and nutrition security in Pakistan by examining three key dimensions: food quantity, quality and economic accessibility using Household Integrated Economic Survey 2015 to 2016 and 2018 to 2019. A study found that dietary intake had decreased by 2% in rural areas and 0.8% in urban areas between 2015 to 2016 and 2018 to 2019. Additionally, 2.1% of households had increased food insecurity during this period, with a greater impact in rural areas. The second most pressing problem of food insecurity is diet quality. Protein deficiency has been observed across the country. A large portion of the population in Sindh, KP, and Balochistan are deprived in micronutrients intake such as calcium, iron, zinc, and vitamins B1, B2, B3, C, and A. The cost of food has also risen due to inflation between 2015 to 2016 and 2018 to 2019, meaning that households have less access to nutritious food. The governments of Sindh, KP, and Balochistan need to do more to combat food insecurity and ensure that rural areas have enough healthy food for low and medium-socioeconomic households. Provincial-level efforts play a crucial role in mitigating the catastrophic loss of life and achieving sustainable development goals, especially the goal of zero hunger.

Socioeconomic Disparities in Family Well-Being, Family Communication Quality, and Personal Happiness among Chinese: Findings from Repeated Cross-Sectional Studies in 2016–2023

AbstractSignificant socioeconomic changes in Hong Kong have coincided with a conspicuous knowledge gap regarding the impact of disparities on family well-being, family communication quality, and personal happiness. To examine changes on family well-being, family communication quality, and personal happiness before, during, and after the 2019 social unrest and the COVID-19 pandemic in Hong Kong. Five repeated territory-wide cross-sectional surveys were conducted from 2016 to 2023, using telephone and online surveys on 27,074 adults in Hong Kong. Respondents rated their family health, happiness, harmony (family 3Hs), family communication quality, and personal happiness on scales of 0–10. Family well-being was the sum of family 3Hs divided by three (0–10). Trends by socioeconomic factors were analysed using linear prediction and multiple linear regression, weighted for sex and age. Highest scores for all outcomes were observed in 2016 and 2017, followed by a noticeable decline in 2020 and 2021, with the lowest scores recorded in 2023 except for personal happiness with its lowest score recorded in 2021. The decline since 2021 was most noticeable with low monthly household income (predicted margins in 2023 ranged from 5.55 to 6.46 for ≤ HK$19,999; 5.62 to 6.51 for HK$20,000–39,999; 5.81 to 6.78 for ≥ HK$40,000), but no differences were observed by education level. Female, older age, and higher monthly household income were significantly associated with higher family well-being, family communication quality, and personal happiness (all P &lt; 0.001). Higher education level was only significantly associated with personal happiness (P = 0.008). We have first shown socioeconomic disparities in the declining family well-being, family communication quality, and personal happiness from 2016 to 2023 in Hong Kong. These alarming findings require targeted interventions and policies aimed at addressing these disparities and improving wellbeing in the population.

Status and influencing factors of knowledge, attitudes and practices relating to screening for breast and cervical cancer among rural women aged 40–65 years in China: a cross-sectional study

ObjectivesThe objectives are to investigate the status of knowledge, attitudes and practices (KAP) and to identify factors related to KAP towards breast and cervical cancer screening among rural Chinese women...

Influence factors on travel mode preference of working residents living far away from downtown area on workdays: A hybrid method integrating random parameter logit model and Apriori algorithm

This study presents a detailed analysis on the characteristics of travel mode preference of working residents living far away from downtown area on workdays, using GPS-based activity travel diary data from Shangdi area (Beijing). A hybrid method integrating random parameter logit model with systematic heterogeneity (RPL-SH) and Apriori algorithm is put forward to explore the influence factors and interaction effects affecting travel mode preference. First, the RPL-SH model is established to explore significant factors, and capture the unobserved random heterogeneity and systematic heterogeneity due to individual characteristics on the travel mode preference. Then, these significant factors are used to generate association rules by Apriori algorithm to investigate statistical associations between the specific travel mode preference and these significant factors. Ten significant factors are found in the RPL-SH model, in which annual household income is normally distributed. The results of the Apriori algorithm indicate that some factors combined with other factors could significantly influence working residents’ travel mode preference. For example, the combination of lower annual household income and shorter distance between workplace and the nearest bus stop is highly associated with green travel mode preference. Moreover, the results show that the proposed hybrid method not only demonstrates the consistency of the results of the two methods, but also plays a complementary role in exploring more information on travel mode preference. This research hopes to give regulators a better understanding on how working residents living far away from downtown area choose their travel mode, so as to develop more effective and targeted measures for reducing private car use and alleviating workday traffic congestion.

The role of personality, empathy, and the perception of the instructor's caring on nursing students' burnout: A cross-sectional study

AimThe present study aimed to evaluate the contribution of personality, empathy, and the perception of instructor's caring in predicting burnout in nursing students. BackgroundBurnout is alarmingly prevalent and rising among nursing students. Furthering our understanding of individual and clinical environmental antecedents of burnout is crucial to shield nursing students' well-being during their training. MethodsIn a cross-sectional study design, the Ten Item Personality Inventory (TIPI), the Brief version of the Interpersonal Reactivity Index (BIRI), the Nursing Students' Perception of Instructor Caring (NSPIC), and the Copenhagen Burnout Inventory (CBI) were administered to 361 (83.9 % females) Italian nursing students between July and December 2021. t-Tests, analyses of variance, Pearson's correlations, and hierarchical regressions were performed to examine the association of CBI with socio-demographics, TIPI, BIRI, and NSPIC. ResultsBeing female and having a low household income were predictors of Personal Burnout and Work-related Burnout. Personal Burnout was positively associated with TIPI-Neuroticism and BIRI-Personal Distress. Work-related Burnout was positively associated with BIRI-Personal Distress and NSPIC-Control, and negatively associated TIPI-Openness to Experience, NSPIC-Support, NSPIC-Confidence. Client-related Burnout was negatively associated with TIPI-Agreeableness, NSPIC-Support, NSPIC-Confidence. Beyond the effect of socio-demographics, TIPI, and BIRI, NSPIC subscales significantly contributed to the explained variance in CBI scores. ConclusionsSex, household income, personality, and empathy should be considered when designing interventions to decrease burnout in nursing students. Promoting caring relationships between clinical instructors and their pupils may contribute to reduce nursing students' burnout.

Medicaid Status is Independently Predictive of Increased Complications, Readmission, and Mortality Following Primary Total Shoulder Arthroplasty

In recent years, several studies have evaluated the effect of Medicaid insurance status on total shoulder arthroplasty (TSA) outcomes and have presented discordant findings. The purpose of this study is to determine if Medicaid status is an independent predictor of all-cause complications, readmission, revision, and mortality following elective primary TSA using a large, national administrative claims database. The Nationwide Readmissions Database (NRD) was queried to identify patients who underwent elective primary TSA from 2016 to 2020. Patients were propensity score matched in a 1:1 proportion based on age, sex, and discharge weight, yielding 15,374 Medicaid cases and 15,448 control cases. Patient demographic and discharge information, preoperative comorbidities, and postoperative outcomes were compared with bivariate analysis. Binary logistic regression was performed to account for the influence of variables other than Medicaid status on postoperative outcomes. Medicaid patients had higher rates of preoperative comorbidities, higher Charlson-Deyo Comorbidity Index scores, and lower household incomes than matched controls. Compared to controls, Medicaid patients undergoing TSA had higher odds of adverse clinical outcomes, including all-cause complications, readmission, and mortality within 180 days, along with other specific medical and implant-related complications including broken hardware, dislocation, prosthetic loosening, and surgical site infection. Medicaid status was independently predictive of increased rates of all-cause complications within 180 days, readmission within 180 days, dislocation, pneumonia, sepsis, and decreased rates of prosthetic loosening. Medicaid patients had an increased mean cost of $1,396 and increased mean length of stay of 0.4 days. Medicaid status was independently predictive of readmission, complications, and mortality within 180 days of primary TSA, as well as other specific medical and surgical complications. Medicaid patients experience higher admission costs and longer hospital stays compared to those with other insurance types. Medicaid status is a risk factor for adverse clinical outcomes, and orthopedic surgeons need to consider the multitude of disparities that Medicaid patients experience when determining surgical options, treatment plans, and hospital disposition.

Unveiling soil-transmitted helminth infections and associated risk factors in rural primary schoolchildren in Malaysia.

Soil-transmitted helminths (STHs) are known as one of the neglected parasitic diseases, leading to significant health issues and associated complications. This study aims to assess the current prevalence of STH infections and the associated risk factors among rural primary schoolchildren in Malaysia. A cross-sectional study was conducted among 638 schoolchildren (7-11 years old) from 10 rural primary schools in five regions of Malaysia. The overall prevalence of STH infections among schoolchildren was 54.5%, with T. trichiura being the predominant STH species (50.9%), followed by A. lumbricoides (19.6%) and hookworms (7.4%). The highest prevalence of STH infections was recorded in the schools in Perak (96.6%), followed by Pahang (85.4%), Johor (42.1%) and Sabah (6.2%). At the same time, none of the schoolchildren in Sarawak were infected with STHs. The findings also highlighted that the older age group (10-11 years old) exhibited a higher prevalence of STH infection and T. trichiura compared to those aged 7-9 years old (P = 0.01) among the schools with a high prevalence of STH infections (>= 70%). Several variables, such as being female (1.9 [1.2, 3.0]) (Adjusted odd ratio [95% confidence interval]), low household income (30.9 [7.0, 136.5]), using untreated water supply (1.9 [1.1, 3.2]), indiscriminate defaecation (1.9 [1.1, 3.1]), indiscriminate garbage disposal (2.8 [1.3, 6.0]), eating with hands (5.9 [3.4, 10.4]) and experiencing pallor signs (2.3 [1.1, 5.0]), emerged as significant predictors of STH infections in this study population. The present study underscores that in specific rural community areas of Malaysia, STH infections continue to pose health concerns among primary schoolchildren. Hence, to ensure the sustained effectiveness of the measures taken to control STH infections, a collaborative and ongoing effort between various stakeholders is imperative to provide targeted support to rural communities, especially those in areas lacking essential amenities and healthcare services.

The relation between socioeconomic status and invasive haemodynamics at evaluation for advanced heart failure.

Socioeconomic deprivation is a risk marker for worse prognosis in patients with heart failure (HF), and a potential barrier to referral for advanced HF evaluation. The relationship between socioeconomic status (SES) and invasive haemodynamics in patients undergoing evaluation for advanced HF therapies is unknown. We combined a consecutive clinical registry of patients evaluated for advanced HF with patient-level data on SES (household income, education, workforce status, cohabitant status and distance from home to tertiary HF centre) derived from nationwide registries. Using this information, the cohort was divided into groups of low-, medium- and high degree of socioeconomic deprivation. The associations between SES and invasive haemodynamics were explored with multiple linear regression adjusted for age and sex. A total of 631 patients were included. The median age was 53years, and 23% were women. Patients in the highest income quartile versus the lowest (Q4 vs. Q1) were older (median age 57 vs. 50years) and more often male (83% vs. 67%), both P<0.001. Increasing household income (per 100000 Danish kroner,1 EUR=7.4 DKK) was associated with lower pulmonary capillary wedge pressure (PCWP)[-0.18mmHg, 95% confidence interval (CI) -0.36 to -0.01, P=0.036] but not significantly associated with central venous pressure (CVP) (-0.07mmHg, 95% CI -0.21 to 0.06, P=0.27), cardiac index (-0.004L/min/m2, 95% CI -0.02 to 0.01, P=0.60), or pulmonary vascular resistance (PVR) (-0.003 Wood units, 95% CI -0.37 to 0.16, P=0.84). Comparing the most deprived with the least deprived group, adjusted mean PVR was higher (0.35 Wood units, 95% CI 0.02 to 0.68, P=0.04), but PCWP (0.66mmHg, 95% CI -1.49 to 2.82, P=0.55), CVP (-0.26mmHg, 95% CI -1.76 to 1.24, P=0.73) and cardiac index (-0.03L/min/m2, 95% CI -0.22 to 0.17, P=0.78) were similar. Most haemodynamic measurements were similar across layers of SES. Nevertheless, there were some indications of worse haemodynamics in patients with lower household income or a high accumulated burden of socioeconomic deprivation. Particular attention may be warranted in socioeconomically deprived patients to ensure timely referral for advanced HF evaluation.

Climate change, livelihood resilience, and gender: An intersectional analysis of Vietnam's forest-dependent communities

Integrating gender-disaggregated data and adopting a gender-focused perspective are crucial for a comprehensive understanding of climate change issues. This study provides empirical evidence from two ethnic minorities in Vietnam, highlighting how perceptions of livelihood resilience vary by gender, geographical context, and ethnicity, with a particular emphasis on their intersections. Over 13 months, data were gathered through 3 focus group discussions, in-depth interviews with 9 key informants, field observations, and surveys of 136 households. The findings revealed a low average Household Livelihood Resilience (HLR) score of 0.434, indicating limited resilience among forest-dependent households facing external shocks. Notably, a significant gender gap was evident, with men demonstrating higher resilience levels than women, a disparity attributed to entrenched social norms and cultural practices. Women, often confined to domestic roles, faced barriers to community involvement and access to financial resources, which weakened their ability to cope with and recover from adverse events. To address these issues, the study advocates for climate actions that prioritize gender equality and aim to enhance women's resilience. This includes amplifying their voices through tailored training programs and initiatives such as women-managed microfinance groups. The study also emphasizes the policy implications for advancing gender equality, sustainable forest management, and livelihood resilience. However, this work has limitations, including a small sample size and reliance on self-reported data, which may introduce biases. Future research should involve a larger, more diverse sample of forest-dependent communities and examine various dimensions of vulnerability to provide a more nuanced understanding of resilience factors.

Associations between changes in deprivation and alcohol use disorder: a nationwide longitudinal study.

Despite conflicting findings on the association between socioeconomic status and drinking, little is known about the impact of deprivation as a measure of inequality on alcohol use disorders (AUDs). We used the Korea Welfare Panel Study, a longitudinal survey conducted from 2012 to 2022, and included 1569 Korean adult participants. Deprivation (at least one including food, housing, medical, educational, and credit deprivation) was measured by self-report and divided into four categories according to the change in deprivation experience from the previous year to the following year. AUD was measured using the Korean version of the Alcohol Use Disorders Identification Test scale. Multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals and adjusted for confounders. Among 1569 participants, worsened deprivation and consistent deprivation were positively associated with AUD compared to non-deprivation. In particular, worsened deprivation was more likely to be associated with AUD in participants with low household income, high school education level, and economic activity. We found that worsened deprivation and consistent deprivation were associated with AUD. Deprivation should be considered as a health policy intervention to improve drinking problems.